MEDICARE: DR. JEFFREY LEO MILLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY00986	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PY00986	OTHER	MO	MISSOURI LICENSE NUMBER
2	09779039	OTHER	MO	BLUE CROSS ID

General Provider Information

NPI Number	:	1700806098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LEO MILLER PH.D.

Provider Business Mailing Address
First Line	:	1924 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	816-224-6500
Fax Number	:	816-224-2777

Provider Business Practice Location Address
First Line	:	1924 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	816-224-6500
Fax Number	:	816-224-2777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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